N.J. Admin. Code § 10:74-13.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:74-13.1 - Reporting requirements

(a) Each contractor shall furnish such timely information and reports as the Division may find necessary, and on such forms or in such format as the Division may prescribe, as specified in the contract. Such reports shall include information sufficient for Division management, monitoring and evaluation purposes in at least the following areas, but not limited to:

1. Enrollment and disenrollment;

2. Encounter data at a level of detail specified in the contract, and enrollee identification data;

3. Utilization data for covered services provided under the contract;

4. Utilization data for family planning services;

5. Financial data;

6. Third-party liability (TPL) information as required by the contract;

7. Network adequacy; and

8. Quality indicators and measurements.

(b) The contractor shall submit to the Division at least annually, information specified by the Division on non-Medicaid/NJ FamilyCare enrollees for purposes of comparative analyses of service use and cost patterns.

(c) Each contractor shall maintain records in accordance with 45 C.F.R. 74, and other applicable State and Federal law, and make available to authorized personnel of the Division all records created pursuant to 10:74-2.1 and 10.1.

(d) The contractor shall maintain a uniform accounting system that adheres to generally accepted accounting principles.

(e) The contractor shall collect and analyze data to implement effective quality assurance, quality improvement and utilization review programs. The contractor shall review and assess data using statistically valid sampling techniques.

(f) The contractor shall agree to make appropriate provisions to physically secure and safeguard documents and files related to the State of New Jersey pursuant to 42 CFR Part 431, Subpart F.

(g) All significant changes that may affect the contractor's performance under the contract shall be immediately reported to the Division.

(h) The contractor, with the prior written approval of the Division as to form and content, shall arrange for the distribution of informational materials to all subcontractors providing services to enrollees, outlining the nature, scope and contract requirements.

N.J. Admin. Code § 10:74-13.1

Amended by 51 N.J.R. 1359(a), effective 8/19/2019